The time is now - mums waiting for family planning services by DFID. CC BY 2.0.

Every birth wanted: family planning

The International Conference on Population and Development, which took place in Cairo in 1994, established the right of men and women to be informed and have access to safe, effective, affordable and acceptable methods of family planning of their choice. Here, Dr Jenny Cresswell defines some of the principles of family planning, including contraceptive prevalence rate, modern and traditional methods of contraception, and unmet need.

Family planning programmes historically have focused on enabling married women to space their births and limit their family to a desired size.1 There is some debate over whether the term is becoming less relevant in the 21st century, when it is increasingly acceptable for adolescents and unmarried women to be sexually active and potentially wish to prevent pregnancy without necessarily thinking about planning a family.1-3 An alternative is to use the more biomedical term: contraception.

There are a large number of indicators for monitoring the progress of family planning programmes, which can be tracked through organisations such as FP2020. The two most frequently used key indicators for monitoring the progress of family planning programmes are the contraceptive prevalence rate and unmet need for family planning.

Contraceptive prevalence rate

The contraceptive prevalence rate (CPR) is defined as the percent of women who are currently using, or whose sexual partner is currently using, at least one method of family planning regardless of the method used. The CPR is usually presented for women aged 15 to 49 years, and may be reported for all women, or for women who are currently married or in a union.

Globally CPR is increasing: from 55% in 1990 to 63% in 2010.4 However, the rate of increase was significantly slower in 2000-2010 compared to the 1990s. CPR remains low in Sub-Saharan Africa: in western and middle Africa fewer than 20% of women use any method of contraception.4

Modern vs traditional

Family planning methods can be divided into modern methods and traditional methods. Modern methods of contraception include female and male sterilisation, the intra-uterine device (IUD), the implant, oral contraceptive pills, injectables, male and female condoms, vaginal barrier methods and emergency contraception. Traditional methods of contraception include the rhythm (periodic abstinence) and withdrawal.

From a public health perspective, we often pay particular attention to the prevalence of long-acting reversible methods of contraception (LARCs), namely the IUD and implants. LARCs are highly-effective and reliable methods of contraception, and are also highly cost-effective.

Unmet need

Women with unmet need are those who are both fecund (able to become pregnant) and sexually active, and do not want to become pregnant, but are not currently using any method of contraception. The concept of unmet need is useful because it indicates the gap between women’s reproductive intentions and their contraceptive behaviour.

Globally unmet need decreased from around 15% in 1990 to 12% in 2010.4 Nonetheless, about 146 million women of reproductive age who were married or in a union had an unmet need for any method of family planning in 2010. Unmet need for family planning is highest in Sub-Saharan Africa: above 20% in eastern, middle and western Africa.4 In absolute terms, the greatest number of women with unmet need is found in southern Asia.4